Provider Demographics
NPI:1932181963
Name:PETER, CHARLES ALAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ALAN
Last Name:PETER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29605 US HIGHWAY 19 N
Mailing Address - Street 2:STE 310
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-1540
Mailing Address - Country:US
Mailing Address - Phone:727-785-7202
Mailing Address - Fax:727-785-6985
Practice Address - Street 1:29605 US HIGHWAY 19 N
Practice Address - Street 2:STE 310
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-1537
Practice Address - Country:US
Practice Address - Phone:727-785-7202
Practice Address - Fax:727-785-6985
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10128122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist